THE SARS EPIDEMIC: THE OUTBREAK

THE SARS EPIDEMIC: THE OUTBREAK; Number of Cases in Taiwan May Be More Than Reported

By DONALD G. McNEIL Jr.

Published: May 16, 2003

TAIPEI, Taiwan, May 15—
Even as Taiwan was reporting its biggest one-day jump in probable SARS cases, health officials said today that the outbreak here was being inaccurately counted and was probably much bigger than reported.

The outbreak spread today to another major hospital and to an ambulance service, infecting drivers in ways that have not been traced and doctors wearing full infection gear.

Taiwan said today that its ''probable'' cases of severe acute respiratory syndrome increased by 26, to a total of 264, with 34 deaths.

But the World Health Organization is dissatisfied with the way Taiwan counts its cases, dividing them into ''reported,'' ''suspect'' and ''probable,'' based on how many symptoms a patient shows.

In the absence of a quick, reliable laboratory test, ''probable'' is as specific as the W.H.O. gets. It does not use lesser categories.

Taiwan has more than 1,000 ''reported'' and more than 200 ''suspect'' cases, ''so there may be a lot that aren't counted and we don't even know about,'' said Dr. R. Palmer Beasley, dean of the public health school at the University of Texas at Houston, who complained about the problem to President Chen Shui-bian today.

Dr. Beasley, who spent years here fighting hepatitis B, spoke for the W.H.O., which cannot deal with the government because China objects.

Dr. Lee Ming-liang, the former health minister leading the fight against the epidemic, said Taiwan would conform to W.H.O. standards by next week.

When it does, there may be many new probable cases.

China has 5,124 probable cases and Hong Kong has 1,698.

Throughout the day, the news here grew steadily worse.

Seven doctors and nurses were reported infected at George MacKay Memorial, the biggest religiously affiliated hospital in Taipei, founded by a 19th-century missionary. They had all been in ''full, tight protection,'' a spokesman said, and the hospital could not explain how they were infected.

An ambulance driver, who was a recruit working for the fire department in place of military service, died of SARS today, and his roommate and two other drivers were said to be sick.

City officials said it was unclear how they were infected. Also, the driver, Kuo Kuo-chan, 24, did not quarantine himself when he became feverish, but left for his hometown.

On Wednesday, the country's leading medical center, National Taiwan University Hospital, shut its emergency wards, cut off visitors and called 250 employees back to be quarantined among its more than 1,000 patients. The hospital had been overwhelmed trying to care for up to 150 suspected SARS cases at a time, and cases began to spread in the emergency wards.

Dr. Beasley said the hospital had done a poor job of triage on feverish patients as they arrived.

In Kaohsiung, in southern Taiwan, an anonymous caller to a television station who said he was quarantined inside the large modern Chang Gung Hospital, said morale inside was low and many staff members wanted to quit.

''It's pretty chaotic in here, but management tells us to 'shut up, shut up, don't talk to the media,' '' he said.

Some small hospitals reported cases among staff members.

Although dozens of doctors have now been quarantined, Dr. Lee said he was not yet worried that the health care system was in danger of collapse.

''We still have quite a reserve of doctors,'' he said, ''and these are not all the top infectious-disease specialists in the country. Many of them are low- and mid-level staff.''

What did worry him, he said, was a dangerous combination of mendacious patients and too-casual doctors.

''Patients hide their real history because society gives a negative connotation to a SARS patient,'' he said. ''Like in the early days of AIDS -- people don't want to disclose that they have a SARS patient in their family.''

Doctors are supposed to treat all those with fevers or dry coughs as if they were suspect, ''but they underestimate the problem'' he said, and do not take the proper measures.